Developmental problems in early childhood are common and often go undetected, leading to significant disability. Developmental screening using standardized instruments can improve the detection of developmental delays and allow for referral to early intervention services. Unfortunately, few clinicians utilize standardized screening instruments to identify developmental problems. The American Academy of Pediatrics (AAP) recently issued a recommendation that health care providers conduct developmental surveillance at all well child visits and institute developmental screening at 9, 18, and 30 months of age. This application will address the adaptability, feasibility, and effectiveness of the AAP's evidence-based policy statement regarding developmental screening in an urban primary care setting serving primarily low income African American families. The specific aims of this application are (1) to identify barriers and facilitators to the use of guideline based standardized developmental screening in primary care practice, (2) to assess the feasibility of implementation of two different developmental screening protocols compared with a control condition: standardized developmental screening at 9, 18, and 30 months with support for the implementation of the protocol (Intervention 1) vs. standardized developmental screening at 9, 18, and 30 months with no additional support for the implementation of the protocol (Intervention 2) vs. developmental surveillance alone (control condition), and (3) to determine the relative effectiveness of two different developmental screening protocols compared with a control condition: standardized developmental screening at 9, 18, and 30 months with support for the implementation of the protocol (Intervention 1) vs. standardized developmental screening at 9, 18, and 30 months with no additional support for the implementation of the protocol (Intervention 2) vs. developmental surveillance alone (control condition). The application will employ a mixed methods study design that combines qualitative and quantitative methodologies. In year 1 of the application, urban primary care pediatric practices affiliated with a large children's hospital will be recruited. Focus groups of health care providers and office staff at participating practices will be conducted to identify attitudes, social norms, and perceived behavioral controls including facilitators and barriers to developmental screening. Information obtained from these meetings will be used to adapt a developmental screening protocol for implementation. In years 2-3 of the application, health care providers will be randomized to one of three developmental screening protocols: targeted screening by primary care support staff, targeted screening by health care providers, or surveillance alone. Eligible children will be followed in the intervention for 18 months, and outcome data on identification and referral of developmental problems and enrollment in early intervention will be obtained from electronic health records and early intervention service providers. Surveys of participating health care providers and families will be used to obtain information on the feasibility of the various screening protocols.